NPI | 1174854293 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: KS TMP163070) |
Additional Taxonomies | 111N00000X Chiropractor (Licence: KS 01-05306) |
Enumeration Date | 2010-01-29 |
Last Update Date | 2025-07-13 |